Osteoporosis vs osteoarthritis: similar names, different conditions

Osteoporosis is a condition of the bones: they lose density and strength and become more likely to break. Osteoarthritis is a condition of the joints: the cartilage that covers the ends of bones wears down, causing pain, swelling and problems moving the joint. The Royal Osteoporosis Society says that osteoarthritis is different to osteoporosis, that the similar names cause confusion and that it is possible to have both.

The easiest way to tell them apart is by symptoms. Osteoarthritis is the one that hurts day to day, with joint pain that gets worse the more the joint is used. Osteoporosis is usually silent until a bone breaks. The NHS says the most common injuries in people with osteoporosis are a broken wrist, hip or spinal bones, and that sometimes a cough or sneeze can cause a broken rib or partial collapse of a spinal bone.

The NHS says osteoporosis develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a fracture. Losing bone is a normal part of ageing, but some people lose bone much faster than normal. Women lose bone rapidly in the first few years after the menopause and are more at risk than men, although it can affect men, younger women and children.

The NHS describes osteoarthritis as the most common type of arthritis in the UK, a condition that causes joints to become painful and stiff. Almost any joint can be affected, but it most often causes problems in the knees, hips and small joints of the hands. In osteoarthritis the protective cartilage on the ends of the bones breaks down, and bony growths can develop. The exact cause is not known, but joint injury, age, family history, obesity, being a woman and other conditions that have damaged the joint are thought to increase risk.

The table summarises what the NHS and the Royal Osteoporosis Society say.

For osteoarthritis, the NHS says a GP will ask about your symptoms and examine your joints. They may suspect it if you are 45 or older, have joint pain that gets worse the more you use your joints, and stiffness that is not there in the mornings or lasts less than 30 minutes. Prolonged morning stiffness can be a sign of rheumatoid arthritis instead. X-rays or blood tests are not usually necessary but may be used to rule out other causes.

For osteoporosis, the NHS says your doctor can work out your future risk of breaking a bone with an online tool such as FRAX or QFracture and may refer you for a bone density scan, which takes 10 to 20 minutes and gives a T score.

The Royal Osteoporosis Society points out that the two can interact in testing. Osteoarthritis causes osteophytes, bony lumps that can grow on the spine or around joints. A bone density scan cannot tell the difference between normal bone and osteophytes, so the scan may suggest your bones are stronger than they really are, and your healthcare professional will take this into account.

The NHS says osteoarthritis is a long-term condition that cannot be cured but does not necessarily get worse over time and may sometimes improve. Mild symptoms can be managed with regular exercise, losing weight if you are overweight, suitable footwear and devices to reduce strain on joints. More severe symptoms may need painkillers and a structured exercise plan with a physiotherapist, and in a small number of cases surgery to repair, strengthen or replace a joint.

The NHS says osteoporosis treatment is based on treating and preventing broken bones and taking medicine to strengthen bones, depending on your risk of a future fracture. It recommends regular exercise, foods rich in calcium and vitamin D, a daily 10 microgram vitamin D supplement, giving up smoking and reducing alcohol, along with steps to reduce falls such as removing hazards at home and having regular sight and hearing tests.

The Royal Osteoporosis Society says that staying active is important in both conditions: for osteoarthritis, exercises to strengthen muscles and improve general fitness help, and a healthcare professional can advise how to exercise safely with both.

The NHS says to see your GP if you have persistent symptoms of osteoarthritis so they can confirm the diagnosis and prescribe any necessary treatment. Speak to your GP if you have broken a bone from a minor fall or impact, have a family history of osteoporosis, or have risk factors such as long-term steroid tablets, early menopause or an eating disorder, so your risk can be assessed.